This is a resubmission of an application for a K23 award for Dr. Christine Dehlendorf, whose research focuses on how to improve women's use of contraception, with specific emphasis on communication with health care providers about family planning and on racial/ethnic disparities in reproductive health outcomes. She has conducted two primary data collection projects in these areas and has an observational cohort study that includes audiotaping of contraceptive counseling visits currently underway. Her research training includes completion of a fellowship in Family Planning as well as a Masters in Clinical Research. This award will allow her to develop skills in patient-provider communication, decision science, health information technology, implementation and dissemination science, and health care intervention research. Following completion of this award, she will be in a position to establish an independent research program, including applying for an R01 award to fund a randomized controlled trial of a decision support intervention for contraception. UCSF provides an ideal environment for the development of Dr. Dehlendorf's research career. She has assembled a team of mentors from Family and Community Medicine, Obstetrics and Gynecology, Epidemiology and Biostatistics, and Internal Medicine, and she will have ample logistical and practical support from the Department of Family and Community Medicine, where she is already a member of the faculty. Women in the United States have extraordinarily high rates of unintended pregnancy, with poor and minority women disproportionately experiencing this adverse reproductive health outcome. This high rate of unintended pregnancy is caused in part by the under-use and misuse of effective contraceptive methods. As in the United States all non-barrier methods of contraception require consultation with a health care provider, clinicians who provide family planning have an opportunity to positively impact contraceptive use during contraceptive counseling. Little research has investigated this interaction, however, and there have been few attempts to use decision support in the family planning context. Dr. Dehlendorf's specific aims consist of analysis of her observational cohort study of contraceptive counseling to determine which aspects of counseling are associated with continuation of contraception and use of effective contraceptive methods (Aim 1) as well as to study the extent to which there are racial/ethnic disparities in contraceptive counseling (Aim 2);development of an interactive computerized contraceptive decision support tool for use in waiting rooms of clinics providing family planning services (Aim 3);and pilot testing of this tool in four clinics (Aim 4). The development and testing of this computerized contraceptive decision support tool will be informed by the field of implementation and dissemination science, so that if this intervention is found to be successful, it will be appropriate for widespread application. Through completion of these aims, Dr. Dehlendorf will be ready to submit an application for an R01 grant to fund a cluster randomized trial of this intervention.

Public Health Relevance

Approximately 50% of pregnancies in the United States are unintended, which results in poor maternal and child outcomes and contributes to the cycle of disadvantage experienced by racial and ethnic minorities. Improving the use of contraception has the potential to improve this important public health outcome and decrease reproductive disparities. This resubmission proposes the development and pilot testing of an interactive computerized decision support tool for contraception that is targeted towards the needs of diverse populations and is designed to increase the use of effective contraceptive methods, as well as decrease discontinuation of and improve adherence to these methods.